Alcoholism and scientific progress: recognizing the discovery cure - Perspectives on Current Research

Alcohol Health & Research World,  Fall, 1989  by Enoch Gordis

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Alcoholism and Scientific Progress

Recognizing the Discovery Curve

Alcohol abuse and alcoholism have been problems for humankind for most of history. Only in recent history, however, has there been a concerted effort by scientists to discover the causes and develop prevention measures and treatments for alcohol-related problems--problems that annually cost this country tens of thousands of lives, and billions of dollars.

Research dedicated to solving the riddles of alcohol abuse and alcoholism began, for the most part, with the creation of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in 1970. From a modest portfolio to one that includes internationally respected investigators and high-quality research in a broad range of biomedical and psychosocial disciplines, NIAAA today provides leadership and financial support for approximately 90 percent of all alcohol-related research in the United States.

Most of NIAAA's budget is dedicated to basic and clinical research. Approximately 85 percent of the budget is allocated for extramural research--work conducted by scientists in universities, hospitals, and other institutions across the country--and primarily administered through two major Institute divisions--the Division of Basic Research and the Division of Clinical and Prevention Research. (The Division of Biometry and Epidemiology, although principally an intramural research division, also has a small extramural research function that supports several epidemiological research grants aimed at understanding the etiology of alcohol abuse and alcoholism through broad population studies.)

The Division of Basic Research is responsible for the Institute's scientific program in areas such as the neurosciences, genetics, and alcohol-related medical disorders. In addition, the Division provides ongoing support for 12 multidisciplinary, special-focus National Alcohol Research Centers concentrating on such areas as genetics, neurosciences, social epidemiology, treatment research, aging, and alcohol and immunology. The Division of Clinical and Prevention Research is NIAAA's newest extramural research division. It was created to give greater visibility to the newly developing fields of prevention and treatment research and to bring to alcohol prevention and treatment the same type of rigorous investigation already evident in research aimed at preventing and treating other major diseases.

The remaining 15 percent of NIAAA's research budget supports research conducted by NIAAA staff scientists in two divisions: the Division of Intramural Clinical and Biological Research, which is responsible for the major portion of the Institute's intramural research effort, and the Division of Biometry and Epidemiology.

The Division of Intramural Clinical and Biological Research consists of three laboratories (physiologic and pharmacologic studies, metabolism and molecular biology, and clinical studies) and provides the Institute and the alcohol field with an extra measure of flexibility in undertaking investigations that are of priority interest. The multidisciplinary teams of intramural scientists work on the campus of the National Institutes of Health or in laboratories near NIAAA in Rockville, Maryland. The Division of Biometry and Epidemiology maintains a staff of biometric and epidemiological researchers who develop, analyze, and maintain national alcohol-related data sets.

This collective investment in research has produced results. We know much more than we did a decade ago about alcohol's effects on the individual and society. We now know, for example, that genetic factors, environmental factors, and the interaction of the two are involved in the etiology of alcoholism. We also have learned many of the ways in which alcohol affects the brain and other body organs. More is known about alcohol withdrawal and its treatment, the effects of alcohol on cognition, and the impact of alcohol use on the elderly, information that can be of use to alcohol treatment professionals who must deal on a day-to-day basis with the suffering caused by alcohol abuse and alcoholism.

A LOOK AT THE NATURAL COURSE OF SCIENTIFIC DISCOVERY

Although we have come a long way in our understanding of alcohol abuse and alcoholism, some observers, noting the level of effort and the rapid pace of progress made since 1970, may now be impatient for the definitive answers to what causes alcoholism, how do we prevent it, and barring a universal preventive solution, how do we effectively treat it. Yet, the "discovery curve"--the natural course of scientific discovery from basic research to the clinic--is a progressive but time-consuming process. This principle was well illustrated in the early 1970s by Dr. Julius Comroe, Jr., and colleagues using the chronology of events that led to the development of electrocardiography, among other major advances in the field of cardiovascular and pulmonary diseases. As reported in Science (Comroe and Dripps 1976), the reviewers found more than 30 major scientific milestones (beginning in 1660 with Von Guericke's first electricity machine) and many minor ones that were essential to our ability to record the electrical activity of heart muscle cells. This research advancement took more than 100 years of contributions by hundreds of scientists.